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Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

02 July 2012

CENTER FOR HEALTH LAW AND POLICY INNOVATION OF HARVARD LAW SCHOOL SHARES FINDINGS DEMONSTRATING THE IMPORTANCE OF NATIONAL HEALTH REFORM

Fact sheet offers findings that show the benefits of health reform as U.S. Supreme Court Rules on Patient Protection and Affordable Care Act (ACA)

JAMAICA PLAIN, MASS. – The Center for Health Law and Policy Innovation of Harvard Law School (the Center), applauds today’s U.S. Supreme Court ruling on the Patient Protection and Affordable Care Act (ACA), which upheld the constitutionality of the individual mandate and of the Medicaid expansion, but with limits that have the potential to significantly undermine the Medicaid expansion. The Center has recently found that similar health reforms in Massachusetts have led to significant individual and public health benefits.

“Here in Massachusetts, we have demonstrated that health reforms result in increased access to needed care and treatment for our most vulnerable residents, including individuals with HIV and other chronic illnesses,” said Robert Greenwald, director of the Center.

The Center has released afact sheet that highlights some of the findings of an upcoming report on health reform in Massachusetts. The findings demonstrate that health reforms similar to those included in the ACA lead to significant health benefits.

An individual mandate that requires most adults to carry health insurance, a voluntary Medicaid expansion, and subsidized private health insurance for low-to-moderate income uninsured residents are key reforms included in the ACA that have been in place in Massachusetts since 2006. These initiatives contribute greatly to the following outcomes:

• Between 2006 and 2009, new HIV diagnoses fell by 25 percent in Massachusetts compared to a 2 percent national increase.

Along with these important health outcomes, the Massachusetts Medicaid program has seen decreased inpatient costs for this population, and the Massachusetts Department of Public Health estimates that it has saved over $1.5 billion in HIV health care costs since the reforms, in part due to decreased HIV transmission.

A working draft of the Massachusetts HIV/AIDS Resource Allocation Project is available here.

“Today’s ruling will expand access to care for millions of Americans. However, we are concerned that the Court’s decision that the federal government may not withhold all Medicaid funding for states who choose not to participate in Medicaid expansion will perpetuate unequal access to care and health disparities. It is critical that low-income Americans, including those living with HIV, be able to reap the benefits of health reform,” said Greenwald. He added, “In terms of putting the ACA into action, the devil is in the details. We must continue to advocate to make sure that our federal and state governments implement the ACA in ways that turn the law’s potential for increased access to care into reality.”

Martha Minow, Dean of Harvard Law School, noted, “We have cleared a major milestone today, but the real work is just beginning. As we know from Massachusetts, the gains did not happen overnight. Now is the time to work to ensure that the Affordable Care Act truly translates into access to care for millions of Americans, including our most vulnerable, and that the many promises of health reform are fulfilled.”

The Center for Health Law and Policy Innovation of Harvard Law School works to increase access to healthcare for vulnerable populations, particularly low-income people with chronic illness, as well as to support legal, regulatory, and policy structures that enable people to make healthy lifestyle choices.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position. Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]

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The evidence base is more than P-values and confidence intervals

There is a clear and pressing need to engage policymakers and community stakeholders in the consideration of treatment and prevention options for HIV/AIDS.

This necessity has grown stronger in light of current research showing extraordinary promise of using antiretroviral (ARV) therapies for the prevention of HIV. These ARV-based strategies include a ‘treatment as prevention’ model known as TLC+ (testing, linkage to care, plus treatment) as well as vaginal and rectal microbicides and pre-exposure prophylaxis (PrEP).

Mapping Pathways includes a thorough review of the social, economic and clinical impacts of treatment as prevention and TLC+, as well as microbicides, PrEP, and post-exposure prophylaxis, in the contexts of South Africa, India and the United States. Participation and engagement is at the heart of the study, and stakeholder input across the community, research, policy and governmental spheres will be a core focus in all three countries.

The project’s aim is to provide the research and analysis that communities and policymakers need in order to formulate coherent, evidence-based decisions for HIV/AIDS treatment and prevention strategies in the 21st century.

Mapping Pathways firmly believes that the evidence base is comprised of more than scientific data derived from clinical research – it is more than P-values and confidence intervals. The perspectives, experiences, and collective wisdom of community members and key stakeholders must be valued as much as statistically significant trial results.